This project's goal is to improve medical care processes and patient outcomes in clinical practice settings using routine collection of patient-reported outcomes (PROs) administered by computerized adaptive tests (CATs). The research team will integrate PROMIS data with other data captured during clinical care to deliver clinically useful information to the provider at the point of care in real time. The team will evaluate PROs in a nationally distributed consortium of HIV clinics. This project will leverage extensive resources from the Centers for AIDS Research (CFAR) Network of Integrated Cohort Studies (CNICS); a consortium of 9 clinical research sites providing care for a well-characterized and demographically heterogeneous cohort of >20,000 HIV-infected individuals. CNICS has committed to collection of PRO data. The study's aims include: 1. Develop and assess PROMIS short forms and hybrid CATs for patients with HIV. The team will evaluate five PROMIS I domains in Spanish and English selected by HIV-infected patients, providers, and researchers and will develop and evaluate the two new domains of perceived stigma and positive affect. The team will use high quality mixed qualitative and quantitative methods, modify standard CAT algorithms to ensure that items patients and providers deem important are administered, and analyze PROMIS items for differential item functioning (DIF) and individual- and group-level DIF impact. 2. Determine the effect on care processes and patient outcomes of integrating routine PROMIS CAT PRO data with individually tailored treatment recommendations using a comprehensive health improvement model in nine HIV clinics. The team will engage in quality improvement initiatives to involve stakeholders and overcome barriers to routine PRO collection with PRO and clinical data and tailored recommendations delivered to providers in real time at the point of care. The team will use a randomized controlled trial to determine the intervention's impact on process outcomes, clinical outcomes, and satisfaction with care. 3. Collaborate with the PROMIS Network to add value to the PROMIS initiative. The team will contribute patients, data, and software tools. The team will develop and evaluate techniques to analyze DIF in data collected by CATs. PUBLIC HEALTH RELEVANCE: This project will evaluate the validity of PROMIS domains in patients infected with HIV, making PROMIS applicable to this large, underserved population. The project addresses critical limitations of prior research integrating PRO data into routine clinical care. If successful, this project may influence the shape and content of routine clinical care for patients with HIV.